did the coming of vaccination or antitoxin. As to the diseases besides cancer favor-, ably affected by the treatment, I will state that every case of lupus that I have seen treated with the ray is well or getting well. The same thing can be said of ulcers, either syphilitic or varicose, and all cases of chronic localized eczema. I have had one case of 30 years duration, where it was localized on both ankles, get well after four treatments, but the patient continued to come until he had taken ten. This was four months ago, and he continues well.

As to the successes and failures of the X-ray, basing my conclusions on my own experience, and on reports gleaned from literature on the subject, I venture to say, that the reluctance of the average physician to give the X-ray full credit must be explained entirely from the standpoint of the inexperience of writers, who have not had proper opportunity to judge.

I maintain that the X-ray is as positive a cure for many diseases and much more so for some than medicine or the knife, providing the operator is experienced and intelligent enough to apply it correctly.

There are failures with the X-ray, to be sure, but there are failures also with everything in medicine and surgery. Was there ever a physician who never wrote a wrong prescription, or a surgeon who never made a wrong diagnosis, or a wrong incision?

The sum and substance of all this means that we must have specialists in this as in other work, otherwise we shall always blunder and be more or less in the dark.

Physicians knowing little or nothing about the physics, mechanics, or nature of electricity, buy electrical outfits, but how can they expect brilliant results? One who knows very little about electricity should not expect to give X-ray treatments correctly, any more than he could correctly interpret the heart sounds with the stethoscope before taking a course in auscultation.

The unfitness of the general practitioner to do the best X-ray work withcut special knowledge of electricity, and electrical apparatus, is shown by the number of articles

of a confusing and contradictory nature, which have appeared recently. I predict that ultimately, X-ray work will be done only by specialists.

The specialist in this line of work differs from the general practitioner who uses an X-ray apparatus occasionally, because being a specialist, he devotes his whole time to this particular subject, he treats many patients, he has more complete apparatus and extensive experience, covering a great variety of conditions; consequently he gets more definite and uniform results. In other words he systematizes his knowledge, and develops a control of technique which only experience. can give.

During the past few months the profession has been more or less carried away by the X-ray treatment of chronic diseases. Unscrupulous persons have entered the field and brought discredit upon the whole subject, which it certainly does not deserve, and it is a deplorable fact, that the efficiency and importance of the X-ray has not been realized by the profession at large. I desire to present only that side of the subject. which in my opinion has not been fairly dealt with.

As to the danger of severe burns, so frequently cited, I wish to state, before reporting a few cases, that I have witnessed, assisted at and given altogether probably 10,000 applications of the X-ray, nearly all of them daily treatments, and I have yet to see an X-ray burn that amounted to more than a simple dermatitis.

I think this result is due to the use of a perfectly adjustable tube and the technically exact manner in which it is used, which can only be learned by months of study and experience.

Now, gentlemen, in reporting these cases I have selected them from the classes that had been operated on, and when occurring in the breast, the patient was over 50 years. of age, that is, I shall report cases that were surely malignant. In some of them I have the pathologist's report and in others I have failed to get such confirmation of the diagnosis, as the breasts were not ulcerated.

Mr. D., Ossining, N. Y.-Epithelioma under the left ear, two inches in diameter, extending up back of the ear. It had started 14 years ago and was operated on in 1890 by Drs. Fisher and Helm of Ossining. It recurred and was again removed by Helm in 1892. This patient was operated on in December, 1895, and again at a later date by Dr. Daniel Lewis, and has been since treated by Dr. Sheehan of Ossining. When Dr. Lewis operated, as he has since told me, he removed every adjacent gland. There was some lymphatic enlargement when the patient came to me April 8th. He took in all 33 treatments, and seems to be entirely well. Even the scar tissue of the former operations entirely disappeared.

Miss R., Middle Creek, Penn.-Came to me with a growth back of the uterus, size of a small egg; was recommended to me by some patient who had been treated in Chicago. I could not get the consent of the patient to let me take a clipping, consequently have no microscopic diagnosis. It had every appearance of cancer, but whatever it was, it disappeared after two months' treatment, and she went home perfectly well.

She had been having considerable aqueous and bloody discharge that stopped three weeks after treatment was begun.

Mr. I., Age 64.-Microscopic diagnosis, scirrhous epithelioma of the left side of nose and cheek, of 7 years standing. It was two inches by one and one-half inches, incrusted, and protruded from the face fully one-half an inch, making a very ugly looking wound. He took treatment one month steadily every day, then every other day for another month. Recovery was complete-and thus far remains complete, as shown by photographs in my possession, which I will exhibit for your inspection.

Miss S., New Brunswick, N. J., Age 43-Epitheloma diagnosed at Post Graduate Hospital extending over forehead, two inches in diameter, then down, to corner of right eye, across the nose to the left lower lid. The lachrymal duct included, and half of the upper lid involved. This whole sur

face was incrusted and it had its origin seven years before. It had been burned twice, once four years before, with actual cautery, and again two years ago with electric needles. Her eye was so involved that she could scarcely see anything, I suppose on account of the duct being occluded. She began with me March 15th, and took treatment five times a week for five weeks, at which time the face and eye looked well, with the exception of a bad scar and a red line showing where the trouble had been. She came twice a week until the red line went away, about six times in all, and I told her she need not come any more, but to my surprise she kept on coming declaring that the scar was going away, that she wanted it all to go, and sure enough it entirely vanished. Dr. Wallian, editor of

Mrs. S., Brooklyn, Age 51, Married, One

Mr. S., Newark, Grocer, Age 34.-Carcinoma of liver and bile ducts, diagnosis, microscopic, made in St. Barnabas hospital, six months before he commenced treatment. He was operated on, Dr. Ell simply making an exploratory incision which was immediately closed up and the patient's wife told that he would not live three months. In January he went to Chicago for X-ray treatment. He remained there two weeks, but could not remain longer on account of business, coming to me for treatment February 18th. At that time there was a tumor perceptible to touch through the abdomen, the size of my two fists, very hard and not movable. He was pale, looked as if he already had the cachexia, and I, of course, thought he would die; but he said he felt so much

CASE OF MR. I.

Three weeks after commencing treatment.

Child. Came for treatment May 9th. Tumor size of large orange, axillary glands enlarged, arm not swollen, physical condition good. Tumor had been growing 18 months, never had been operated on, breast nodular and very red, for three inches in diameter,, over center of tumor.

Patient sent by Dr. Blackman of Brooklyn, who advised against operation. Treated every day for two weeks at the end of which, the nodules and redness had entirely disappeared. She has taken treatment every day, with the exception of six weeks in the summer, when she came three times a week. The axillary enlargement disappeared at the end of three months. The breast and gland are now cf normal size, but a little harder than the other gland. I shall have her still continue treatment until the gland softens.

CASE OF MR. I. Six weeks after commencing treatment.

better than before going to Chicago that

I decided to take him and he was treated

time the tumor had almost disappeared. He had very little pain. Subsequently, he was treated irregularly, averaging two treatments a week, until August 1st, when I discharged him, as I had not been able to detect any tumor for a month, and he appeared well.

I think, this case is the first one yet reported, of internal cancer that has recovered after exploration.

Mrs. F., Boston, Age 50.-Tumor of left breast, over nipple, size of hen's egg, and ulceration one inch in diameter adherent to chest walls.

Microscopical

examination discloses squamous cell carcinoma. Tumor had been growing two years; commenced treatment April 26th and was treated every day. At the end of twenty-four treatments the breast had reddened, the tumor was movable, pain had stopped, the ulceration was reduced to one-half inch in diameter. Continued treatment daily for three months at which time she went home on account of business matters. At the time of her leaving the induration had disappeared, and the ulceration was the size of a small pea.

I told her to return if it did not heal. One month ago she wrote me that she was perfectly well. In one week after her return the wound had entirely healed and the breast was soft.

Miss P., Poughkeepsie, Age 52.-Tumor of left breast, induration two inches in diameter and movable; had just noticed it two months before, no axillary enlargement. This patient had been sent to Dr. Silver of Bellevue, who wanted to amputate the whole breast. Patient became frightened and was sent to me. She took thirty treatments, nearly all of them daily and the tumor entirely disappeared. As a precautionary measure she subsequently took one treatment a week for three weeks.

Mrs. W., Brooklyn, Age 39, Married.— Carcinoma of right breast: had it amputated by Dr. Topham of Brooklyn, October 24, 1901, was again removed March 4th, 1902, by Dr. Coley of New York. The nodule having reappeared in six weeks after first.

operation. When she came to me for treatment, April 14th, there was an induration two inches long and an ulceration one and one-half inches long by one-half an inch wide, that had formed in the line of incision. Under the X-ray the wound entirely closed after 21 treatments, and the induration after 15 more. She remained perfectly well when I saw her October 6th.

Mrs. L., Philadelphia, Age 75.-Tumor of left breast 3x4 inches of induration, had been growing four years; no ulceration and no axillary involvement. Began treatment June 18th, and was treated daily for 50 consecutive days at which time the tumor was so reduced that the gland has resumed its normal size, but was still a little hard. She then had to go home but returned in two weeks and had ten more treatments, when she left me apparently as well as ever. No microscopical examination was made as there was no ulceration.

Mrs. G., Newark, Age 58, Married, No children.—Growth removed two years ago with paste, in Binghampton Sanitarium; now size of grape fruit, ulcerated, and ulceration size two and one-half by three inches; breast nodular, and very hard. Axillary glands very much enlarged, right arm very much swollen and circulation interfered with.

ma.

Microscopical diagnosis reveals carcino

Came first for treatment April 5th, took same every day except Sunday for four months at which time her arm was so much worse that I sent her home where she died about six weeks later. Now this case was peculiar in a great many ways; the breast reduced at least one-third under treatment; it softened; the ulceration healed; but the arm kept swelling and the pain grew worse. The only influence that I could see that the treatment had on it was to reduce the size of the breast and heal the ulceration. I could not say that it benefited the glands under the arm one iota, in fact the whole arm grew worse.

Mrs. P., Peekskill, Age 41, Married, 2 Children. Tumor of abdomen size of large

orange, located three inches above and two inches to the right of umbilicus, first noticed November, '91; was diagnosed cancer by Drs. Knight and Hart of Peekskill; patient very anemic; weight 102 lbs.; vomiting every two weeks; has severe pain almost all of the time; very constipated bowels, moving only once in two weeks.

Commenced X-ray treatment February 5th and continued nearly every day, up to within one month of her death in September, 1902. I wish to report this fatal case as an illustration of the good the treatment apparently does even when there is no hope and the cases prove fatal.

After the first month of treatment the tumor was reduced one half in size, the patient rarely vomited, the pain almost subsiding, until the treatment had to be stopped. I mean by that, that she required no anodynes, and the constipation, strange to say, never troubled her. I believe this patient died from general infection, but I also believe that the treatment prolonged her life and made her much more comfortable than she otherwise would have been.

Autopsy showed cancer of pyloric end of stomach of very small growth and no obstruction, but a dilated stomach.

Mr. B., Yonkers, Age 30, Married. -Growth on left side of nose size of black walnut; had been removed by Dr. Warren of Yonkers, three years ago, and again one year ago; had grown rapidly the last few months; left nostril filled with growth.

Microscopical examination showed small spindle-cell sarcoma.

Commenced April 8th, and has taken treatment every day with the exception of Sunday, ever since. The growth has now entirely disappeared from nostril, also from the face. There is still remaining a little induration above where the growth was, but it is rapidly softening.

This case is peculiar in the stubborness of it. I have never seen a small growth move so slowly, and I can't account for it; in fact some of the time during his treatment we were both nearly discouraged with it, but it seems now to be in a fair way to complete recovery.

Mr. H., Fishkill, Age 44, a Hotel Proprietor.-Epithelioma (encephaloid) of lower lip; ulceration size of thumb nail; induration size of hickory nut; had been removed by the knife by a V-shape incision made two years before, by Dr. Frank Tornik of New York City. It had returned about three months ago. He commenced

X-ray treatment the 6th day of June and took thirty-eight treatments, nearly all daily. At the end of the third week, I was discouraged with the case, as the whole line of incision had broken down and was ulcerated. Then it commenced to show signs of immediate improvement, the induration commenced to soften, and the ulceration granulated from the bottom until it was entirely closed, and when he took his last treatment the induration was entirely gone.

These treatments are of 10 minutes duration, the tube is placed from 2 to 8 inches from the patient and the most of the time the tube is kept at what we call a medium vacuum, which means a medium "high tube," the exceptions being the internal cases, where I treat with a high tube, and try to keep the skin red or brown all through the treatment.

In conclusion let me state the disadvantages of the treatment and they are three in number, of course I speak of the treatment when given by some one experienced in the use of the X-ray.

They are: First, The inability of the physician to tell just what cases are going to recover, except of course the more simple

ones.

Second, The length of time that it takes to get the patient well, as it affects every patient differently.

Third, The expense which is quite considerable, when extended over a length of time.

I have twenty-eight cases now under treatment and will report the results in a future paper. 503 Fifth ave.